Spalletta - Associazione Italiana di Psicogeriatria

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Spalletta - Associazione Italiana di Psicogeriatria

Apatia e Depressione

nelle Patologie Associate

all’Invecchiamento

Gianfranco Spalletta

IRCCS Fondazione Santa Lucia


Int. Psychogeriatrics 2010


CLUSTERIZZAZIONE DEI BPSD

(Lawlor et al, 2001)


APATIA E DEPRESSIONE

Sintomi

Apatia Comuni Depressione

Risposta emotiva appiattita Diminuzione dell’interesse Disforia

Indifferenza Rallentamento psicomotorio Ideazione suicidaria

Riduzione delle attività sociali Faticabilità/Ipersonnia Autocritica

Diminuzione dell’iniziativa Ridotto insight Sensi di colpa

Ridotta persistenza (motivazione) Pessimismo

Hopelessness


Am J Geriatr Psychiatry 2009


Anziani istituzionalizzati non dementi

Factor 1:

Depression

Factor 2:

Hyperactiviy

Factor 3:

Psychosis

Factor 4:

Mania

Factor 5:

Apathy

Delusions .072 .115 .873 .064 .053

Hallucinations -.020 .006 .878 .063 -.018

Agitation .263 .768 .186 .243 .077

Depression .775 .118 .155 -.056 .365

Anxiety .781 .052 -.020 .166 .197

Euphoria -.002 .075 .105 .836 -.082

Apathy .270 .163 .057 -.117 .780

Disinhibition .067 .090 .026 .840 .254

Irritability .276 .792 .100 .104 -.106

Aberrant motor behavior -.007 .023 -.015 .294 .745

Nighttime behavior disturbances .737 .190 -.026 -.042 -.174

Appetite and eating abnormalities -.105 .699 -.094 -.090 .311

Int psychogeriatrics, 2010


Proportion of people with different NPI syndromes

undergoing specific psychotropic treatment.


Kaplein Meyer cumulative survival curves.

Progression to dementia in MCI patients with depression or

apathy

Depression

Apathy

J Alzheimer Dis 2010


Risk of developing AD over up to four years in MCI patients with depression or apathy.


Diffusion Tensor Imaging

Ultra-structure damage

"MD"


Mean Diffusivity (MD) Correlates of

Apathy in 20 Amnestic MCI Patients

Panel A: shows the Uncinate Fasciculus

(UF) at Talairach Tournox coordinates

(x=31; and from y=10 to y=8).

Panel B: shows the Inferior Longitudinal

Fasciculus (ILF) at Talairach Tournox

coordinates (x=42; from y=-2 to y=-4).

Panel C: shows the Middle Longitudinal

Fasciculus (MLF) at Talairach Tournox

coordinates (x=47; from y=-8 to y=-10).

Panel D: shows the medial white matter area

including parathalamic white matter (y=-30),

fornix (y=-32), and posterior cingulum (y=-34).

Talairach Tournox coordinates (x=15; from y=-

30 to y=-34).


Diffusion Tensor Imaging

Loss of Anisotropy

"FA"


Microstruttura cerebrale

Soggetti sani di sesso femminile

Fractional anisotropy

Mean Diffusivity


Change in MMSE performance between baseline and one-year follow-up

in patients with and without baseline depression,

stratified by follow-up depression status


Cognitive outcome (change in MMSE between baseline and follow-up)

in 51 patients with baseline depression

according to antidepressant medication use and depression status at follow-up


CONCLUSIONI


APATIA E DEPRESSIONE

Sintomi

Apatia Comuni Depressione

Risposta emotiva appiattita Diminuzione dell’interesse Disforia

Indifferenza Rallentamento psicomotorio Ideazione suicidaria

Riduzione delle attività sociali Faticabilità/Ipersonnia Autocritica

Diminuzione dell’iniziativa Ridotto insight Sensi di colpa

Ridotta persistenza (motivazione) Pessimismo

Hopelessness

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